Analysis: Years of neglect leave sexual health clinics ill-prepared for monkeypox

A person arrives to receive a monkeypox vaccine at the Northwell Urgent Care Center in Fire Island-Cherry Grove, in New York, U.S., July 15, 2022. REUTERS/Eduardo Munoz/File Photo

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CHICAGO/LONDON, July 18 (Reuters) – Sexual health clinics on the frontline of the monkeypox response are already financially stretched, leaving the United States and UK ill-equipped to handle the first major global health trial since the COVID-19 pandemic.

Infectious disease experts say sexual health clinics – which offer confidential diagnosis and treatment – are best suited to identify and treat cases of monkeypox, which mainly affects men who have sex with men.

However, such programs are doing so largely without additional funding, despite years of financial neglect. There is little data on funding for sexual health services globally, but experts agree that the sector is under-resourced.

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This has hampered the response to monkeypox and diverted scarce resources needed to curb rising rates of other sexually transmitted diseases (STDs), sexual health experts in the United Kingdom and the United States told Reuters.

This lack of resources could result in the further spread of monkeypox, they said. According to the World Health Organization (WHO), the outbreak has reached 63 countries.

“This is a gap and a weakness in our public health system that monkeypox has exposed,” Dr. Meg Doherty, director of WHO’s Global Programs on HIV, Hepatitis and STIs.

“Even among high-income countries, funding for sexual health globally is declining or remaining unfunded,” she said.

Although monkeypox is transmitted through sexual contact, the virus can infect anyone who comes into contact with pus-filled wounds, bodily fluids, respiratory droplets, or contaminated linen.

Clinic staff must take extra time to clean exam rooms and purchase additional protective equipment. When added to chronic understaffing, a problem exacerbated by the COVID pandemic, appointments can be hard to come by. Testing equipment in the United States is also in short supply.

Monkeypox has been endemic in parts of Africa for years, but since early May, the virus has spread rapidly to other countries, mostly among gay and bisexual men, who often present with a rash on the area. genital and anal, which doctors may confuse with herpes or syphilis. Of the 11,500 confirmed cases globally, 1,469 are in the United States and 1,856 are in the UK, according to a Reuters report. Read more

In Spain, with 2,447 cases – the most in the world – patients are being seen in hospitals and health clinics. Local health authorities said they added additional testing capacity at the start of the outbreak and the health system was not under pressure.


Figures from a UK charity called the Health Foundation show that the budget for England’s sexual health services was cut by 14% over a six-year period ending in the financial year 2022. UK clinics have yet to receive any new fund to meet additional monkeypox demand.

In the United States, funding for health care and sexual research has also declined, said David Harvey, executive director of the National Coalition of STD Directors (NCSD).

“Monkeypox has shone a bright light on this fact. In general, the STD field has been severely underfunded for 20 to 30 years,” said Harvey, whose group has sought $100 million in funding to address the smallpox outbreak. of monkeys.

Federal funding for STD programs has remained relatively flat over the past two decades — $168.5 million in 2003 versus $152.5 million in 2022 — a 40% drop when accounting for inflation, according to NCSD. State and local investments have also declined, even as STD rates hit all-time highs, according to a 2021 report by the National Academies of Sciences, Engineering and Medicine.

A survey of NCSD membership, released June 12, found that 42.7% of U.S.-based sexual health clinics have access to appropriate testing swabs and less than 20% have appropriate tubes for collecting smallpox specimens. of the monkey for transport to clinical laboratories.

With limited providers and appointment times, clinics must triage patients, giving priority to those with pain or rash or suspected monkeypox. This has neglected asymptomatic patients and those who need other services.

Harun Tulunay, 35, a sexual health advocate who is HIV positive and was recently hospitalized with monkeypox in London, knows friends whose sexual health appointments were delayed or unavailable “because they (clinics) ) are too busy dealing with monkeypox.”

He’s not surprised, having experienced time-consuming decontamination efforts when he was diagnosed.

“We see it overwhelming the clinics,” he said. “If suddenly we have 5,000 cases, what will happen?

Last week, a coalition of sexual health/HIV organizations in the UK called for urgent funding support, seeking £51 million ($60 million) for sexual health services to “contain and eliminate monkeypox” after some clinics reported drastic declines in essential services.

Part of the issue is that funding for HIV and other sexually transmitted infections is largely fragmented, especially in the United States.

“There has been a lot of money for HIV, which is appropriate, but STI has been a poor one,” said Dr. Matt Golden, director of the HIV/STD clinic serving Seattle and King County, Washington state. His clinic has diagnosed half of the monkeypox cases in the area, as well as providing vaccinations and treatment instructions.

Experts in both countries agreed that monkeypox was a wake-up call for more investment in sexual health. “It’s time to do something,” NCSD’s Harvey said.

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Reporting by Julie Steenhuysen and Jennifer Rigby; Additional reporting by Christina Thykjaer in Madrid; Editing by Caroline Humer, Bill Berkrot and Daniel Wallis

Our Standards: The Thomson Reuters Trust Principles.

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